Giffords' skull surgery successful, recovery progressing, doctors say

The skull surgery performed on Rep. Gabrielle Giffords on Wednesday to replace bone removed after she was shot in the head in January went uneventfully and she is making good progress on her recovery, surgeons at Memorial Hermann-Texas Medical Center in Houston reported Thursday. During the 3 1/2 hour procedure, surgeons also implanted a shunt to drain away any fluid that might accumulate in the skull and cause pressure on the brain, Dr. Dong Kim, chair of the department of neurosurgery, said at a news conference.

FOR THE RECORD: An earlier version of this article misattributed remarks made by a surgeon at Memorial Hermann-Texas Medical Center. It was Dr. Dong Kim, not Dr. Gerard Francisco, who said: "I have already started calling her Gorgeous Gabby. She hasn't looked in a mirror yet, but as soon as she does, she'll be pleased." It was also Kim, not Francisco, who noted that surgeons had to shave off all her hair to minimize the risk of infection during the surgery, but that it will grow back quickly.

A section of Giffords' skull was removed following the Jan. 8 shooting in a Safeway parking lot to allow the brain to swell without it being squeezed in a confined space. The removed section of the skull was frozen in hopes that it could be reimplanted. But Kim said that the segment was broken into small pieces by the bullet and that some of the pieces were contaminated by the bullet. Surgeons therefore decided to use a synthetic bone implant that was designed by a computer to fit precisely into the opening in her skull. The implant is made of a porous hydroxyapatite ceramic. Kim said bone cells will naturally deposit in the pores of the implant and, in two years, it will have become fully integrated into her skull.

Kim also implanted a shunt to provide drainage if any more fluid accumulates. The shunt enters the braincase through a tiny hole in the skull behind one ear. A plastic tube is implanted under the skin to carry the fluids to the abdomen, where they are reabsorbed by the body. A pressure sensitive-valve in the shunt opens automatically when necessary to release fluid. If no fluid builds up, the shunt shuts off by itself. A magnet can be used to change the sensitivity of the valve. The shunt "is entirely under the skin, and not visible," Kim said. "Nobody can tell someone has it." Often, even the wearers forget it is there, he added.

Giffords had been wearing a helmet to protect her brain in case she fell during rehabilitation, but will now no longer have to wear it, doctors said. Giffords' chief of staff, Pia Carusone, said the congresswoman was delighted to no longer have to wear it.

Giffords' head is still swathed in bandages, but Kim said, "I have already started calling her Gorgeous Gabby. She hasn't looked in a mirror yet, but as soon as she does, she'll be pleased." He noted that surgeons had to shave off all her hair to minimize the risk of infection -- about 5% to 10%, much higher than for other surgeries -- during the surgery, but that it will all grow back quickly.

Dr. Gerard Francisco, chief medical officer of Memorial Hermann, added that "She is recovering very nicely. Her cognition has improved significantly, and we are having more meaningful and fun conversations. She has cracked me up several times."

Added Kim: "For a person to come this far in [only four months] after the kind of injury she had is almost miraculous. She has made tremendous progress. But we can't predict how much more she will make going forward. We can't predict if and when she can return to work."

Giffords was shot during an event she held to meet with her constituents. Jared Lee Loughner has pleaded not guilty to charges in the attack and is in custody. Six people were killed in the attack and 12 others wounded in addition to Giffords.